Bridging the Health Care Gap Through Telehealth Case Study Paper For this assignment, read the following case study from the Common Wealth Fund titled Brid

Bridging the Health Care Gap Through Telehealth Case Study Paper For this assignment, read the following case study from the Common Wealth Fund titled Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models.

Write a 2-3 page paper that analyzes the case study. Consider the following:

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1) How is the model of healthcare described in the case study unique?

2) Would the model described in the case study be appropriate to incorporate into the United States Healthcare System?

3) What challenges may arise as a result of incorporating such a model into the United States Healthcare System?

4) How would the model of healthcare described in the case study potentially improve healthcare in the United States?

5) Explain why you would/would not be supportive of this type of healthcare model.

Your paper should include a title page, introduction, body, conclusion, and reference page, per 6th edition of the APA Publication Manual. Use of headers to direct reader attention is encouraged. Review the rubric for additional grading details.

The use of two references, other than your textbook, is required. CASE STUDY
FRUGAL INNOVATIONS IN HEALTH CARE DELIVERY
AUGUST 2017
Bridging the Health Care Gap Through
Telehealth: The MedicallHome and
ConsejoSano Models
Andrea Taylor
Erin Escobar
Krishna Udayakumar
Senior Research Manager
Innovations in Healthcare
Research Manager
Innovations in Healthcare
Director
Duke Global Health Innovation Center
PROGRAM AT A GLANCE
KEY FEATURES: MedicallHome connects subscribed patients
throughout Mexico with doctors in a Mexico City call center.
Using standard protocols, doctors resolve issues or refer callers to
providers in national network of clinics, labs, and hospitals that
offers discounts to program members.
TARGET POPULATION: Low- and middle-income people.
WHY IT’S IMPORTANT: In many developing nations, the public
health system is unable to meet demand for services, driving people
to seek costly services in the private sector.
BENEFITS: Expands access to care while, in some cases, reducing
unnecessary use of services, such as immediate acute care for non–
health emergencies. An adaptation of the model, ConsejoSano, was
launched in the United States in 2014, connecting Hispanic residents
to the same call center in Mexico.
CHALLENGES: In the ConsejoSano model, physicians in the Mexico
City call center serve as advisors, supporting effective navigation
of local health resources rather than establishing doctor–patient
relationships — an adaptation that makes the model viable in the
U.S. Creating a national call center in the U.S. would be difficult,
given state licensing regulations for doctors.
KEY TAKEAWAYS
Mexico City–based
MedicallHome provides 24/7
telephone access to licensed
doctors, along with deeply
discounted access to a large
national network of clinics, labs,
and hospitals.
argeted primarily to low- and
T
middle-income households,
packages are priced at $2 to $5
per month.
With Mexico’s public health
system unable to meet
the demand for services,
MedicallHome has expanded
access to care while reducing
use of acute care for
nonemergencies.
Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models
2
BACKGROUND
KEY PROGRAM FEATURES
Nearly all of Mexico’s 120 million citizens are covered by
public insurance through plans linked to their jobs or
through a nationally subsidized program known as Seguro
Popular. Despite near-universal coverage, the Mexican
government’s total public spending on health care is
relatively low — 3.3 percent of gross domestic product
(GDP) in 2014 — compared with public spending in more
developed nations such as the United Kingdom (7.6% of
GDP) and the United States (8.3% of GDP). Mexicans have
one of the highest rates of out-of-pocket spending in Latin
America, at 44 percent of all health expenditures.1
Rapid Response and Standard Protocols
Although health services in Mexico are provided free
The Healthcare Contact Center at the heart of the of the
at the point of care, the public system does not have the
capacity to fully meet demand, leading to long wait times
to see primary care providers and specialists.2 Rather than
waiting, many people prefer to pay out of pocket to see
private providers, despite the financial strain.
MedicallHome model is staffed by 60 general practitioners,
nutritionists, and licensed psychologists, all of whom
must have at least two to three years of clinical experience.
They also are required to continue practicing outside of
the call center to maintain and strengthen their clinical
skills. Doctors answer calls on average within 10 seconds
and use standardized protocols developed in partnership
with the Cleveland Clinic to identify emergencies within
two minutes. With an average of 500,000 calls per year,
the doctors resolve 62 percent of cases by phone and refer
the remaining cases for in-person treatment. Mexican
regulations prohibit doctors from prescribing medication
over the phone without an in-person consultation, a
policy that partially drives these referrals.
Mexico does, however, have one of Latin America’s
most sophisticated telecommunications industries as
well as one of its fastest-growing middle classes. To the
founders of MedicallHome, these two factors presented
a market opportunity to expand access to health care
through telemedicine.3 “We thought we could provide
complementary health services to what was already
available in the public and private sectors,” says Jorge
Woolf, CEO of MedicallHome’s parent company, Salud
Interactiva (Interactive Health). “We could make care
affordable, available, [and] accessible.”
MedicallHome, a brand of the company Salud Interactiva,
provides telephone access to licensed doctors 24 hours
a day, seven days a week, along with deep discounts at a
national network of more than 10,000 health care providers
in clinics, labs, and hospitals. Primarily targeting low- and
middle-income households, MedicallHome packages are
priced from $2 to $5 per month for a range of services. At
the top range, the package includes life insurance, dental
and vision discounts, and retail discounts, in addition to the
standard MedicallHome service.
Mexico’s telecommunications industry is one of the most sophisticated
in Latin America and reaches nearly all parts of the country. Rapid
growth of landline coverage began in 1997, encouraged by
regulatory changes.4 More recent growth in the mobile
phone market, particularly through prepaid contracts
that enable access for low-income populations,
has made Mexico a leader in use of mobile
phones, even in rural areas.5
commonwealthfund.org
Case Study, August 2017
Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models
3
Affordable and Timely Access to Providers
Designed to Complement Existing Services
MedicallHome subscribers receive timely and affordable
services from a national network of providers in primary
care and specialist clinics, labs, pharmacies, and hospitals,
with coverage in every state and nearly 300 cities. Because
of the high customer volume, MedicallHome can negotiate
significant discounts with these providers.
MedicallHome was developed to complement, not replace,
medical insurance. As noted above, Mexico’s public health
care delivery sector is unable to meet demand, and even
low-income populations spend significant amounts of
money out of pocket on private care. This creates a prime
market for MedicallHome, which is perceived as more
affordable and convenient than alternatives.
It also has leveraged the high volume of subscribers to
negotiate discounts on life insurance, eye care, and dental
services as well as restaurants, entertainment, and travel.
THE MEDICALLHOME MODEL IN ACTION
When calling the Healthcare Contact Center,
patients can press 1 for an emergency, 2 for
medical advice, and 3 for a medical referral.
Emergency calls are identified on the screen
and ring on a different phone. Emergency calls
are answered in less than five seconds. If all
doctors are on other calls when an emergency
Moreover, because of the national surplus of general
practitioners, MedicallHome can recruit high-quality
doctors.6 General practitioners in Mexico typically hold
positions at multiple hospitals and clinics and may have a
private practice on the side. Shift work at a call center can
be relatively easy for them to fit into their schedules.
Salud Interactiva’s leaders report that their providers can
handle minor medical issues, such as consultations and
laboratory tests, more efficiently than those employed by
insurance companies, enabling insurance companies to
focus on covering major medical events, such as surgery
or hospitalization. Several private insurance companies
have developed formal partnerships with MedicallHome
to leverage this advantage, with some companies covering
the cost of a MedicallHome subscription.
call comes through, one will put their call on
hold to take the emergency call. In emergency
BUSINESS MODEL
situations, the call center doctor coordinates
MedicallHome was launched in 1998 with two doctors
and one customer service representative. The company
first tested a toll line before turning to direct sales through
industry partners, a business model that has enabled it to
expand rapidly throughout Mexico and form partnerships
across sectors.
an ambulance, provides recommendations for
emergency care, and stays on the line until the
ambulance arrives.
Call center doctors have, for example, helped
guide a woman and her companion through
labor and delivery (she gave birth before the
ambulance arrived). In rare cases, such as with
an 80-year-old patient experiencing respiratory
complications, a call center doctor may be
dispatched to callers’ homes to further assess
the situation.
commonwealthfund.org
Salud Interactiva builds all infrastructure, support
services, and information technology platforms (including
mobile apps, call center software, and electronic health
records) in house. It reaches new customers through
corporate partnerships with major telecommunications
and banking companies, including Telmex, the largest
phone service provider in Mexico. A telemarketing
campaign enrolls customers of these partner companies
in its services. The company also reaches new customers
by developing creative commercial partnerships. For
Case Study, August 2017
Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models
4
example, a traveler purchasing a bus ticket with a
and immediate acute care. The remainder may need
partnering bus company can pay an additional 10 pesos
urgent care but can avoid emergency departments and
(USD0.60) and access MedicallHome services during the
ambulance service, resulting in savings for the patient
trip. University students can purchase insurance from
and the health system. In addition to the potential for cost
their school, including a MedicallHome subscription, for
reduction, the MedicallHome model provides a pressure-
300 pesos (USD18.50).
release valve in an overburdened public health system.
MedicallHome’s subscription model creates a steady
revenue stream, keeps overhead low, and provides
an efficient channel for billing through partners.
MedicallHome is profitable and earnings grow every year.
The MedicallHome model launched in the Philippines in
July 2015 as Konsulta MD, a joint venture between Salud
Interactiva and Globe Telecom, the Philippines’ primary
telecommunications provider, with 40 million customers.
Filipinos are being offered a basic package (Healthcare
Contact Center and ambulance referrals when needed),
priced at PHP149 (USD3.20) per month for a family.
Konsulta MD has established its own call center in the
Philippines. Filipino regulations allow doctors to prescribe
medications by telephone, averting the need for some
referrals and generating additional savings for customers.
The partners expect to realize profits within two years.
RESULTS
MedicallHome tracks adherence to clinical standards
and customer satisfaction. During each shift a supervisor
audits 5 percent to 10 percent of all calls to measure
fidelity to clinical protocols. Call center dashboards
measure additional indicators related to provider
etiquette, such as active listening (number of times a
question is repeated), and these data are reviewed by
supervisors during each shift. The company also regularly
surveys customers to assess their satisfaction with the
call center and provider network. There has not been an
Potential for Spread in the United States
Elements of the MedicallHome model have been adapted
to the U.S. through ConsejoSano (Healthy Advice), a
joint venture launched in 2014 by Salud Interactiva and
an independent, U.S.-based team. ConsejoSano founder
and CEO Abner Mason saw an opportunity to leverage
elements of the MedicallHome model to meet the needs
of the millions of Spanish speakers living in the United
States. After soliciting guidance from multiple law
firms regarding telemedicine regulations, ConsejoSano
created a model its leaders believe satisfies U.S. regulatory
requirements, particularly around licensure.
ConsejoSano is designed primarily as a health navigation
service, analogous to a personalized WebMD. Subscribers
have 24/7 telephone access to the MedicallHome
evaluation of the model’s impact on clinical outcomes.
Healthcare Contact Center but, because of practice
This approach has the potential to reduce inefficient
only; they are not considered to have physician–patient
utilization of health care. For example, 6 percent of all
relationships with ConsejoSano clients. Callers are
MedicallHome callers believe they are experiencing
prompted to select advice related to general health,
a medical emergency. Of this population, call center
emotional health, or nutrition (with a focus on diabetes
physicians determine that only 12 percent are
and obesity). The call is then routed to the MedicallHome
experiencing emergencies that require an ambulance
call center in Mexico.
commonwealthfund.org
limitations, the Mexican doctors act as health advisers
Case Study, August 2017
Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models
5
Unlike the MedicallHome model, which targets customers
are the fastest-growing population in the U.S.; they are
through telecommunications companies, ConsejoSano
now nearly a fifth of the population and are projected
subscriptions are marketed primarily to large employers
to reach 30 percent by 2050.7 Yet many Hispanics are
and health plans, though subscriptions are also sold
uninsured or underinsured.8 Through the Affordable
directly to consumers. Every caller has a unique ID, which
Care Act (ACA) health insurance expansions, millions of
the call center doctors can use to look up their employer
Hispanics are projected to become newly insured.9 Indeed,
(if applicable), health information on record, and location.
The doctors use standard MedicallHome protocols to
determine whether callers need basic advice or should be
4.2 million Latino adults gained insurance coverage in
2014 and early 2015.10 However, there are not enough
Spanish-speaking providers in the U.S. to meet demand.
referred to a clinician.
Many Hispanics disengage from the health care system
Priced to attract low-income workers, the annual
about how it works.11 ConsejoSano’s focus on health
subscription is $60 for an individual or $120 for a family
of up to five when purchased through an employer or
health plan. Employers and health plans may choose to
partially or fully subsidize the cost of the ConsejoSano
membership. A member’s first call initiates the annual
membership fee and activates unlimited use of the service
for a year. When sold directly to consumers, the plan
is $120 per year for an individual or $180 for a family.
Initially, ConsejoSano is marketing its services in the five
states with 65 percent of the Hispanic population in the
U.S.: California, Florida, Illinois, New York, and Texas.
because of language barriers and lack of knowledge
system navigation is intended to help its members more
effectively access local health networks.
The vast majority of ConsejoSano calls are resolved by
phone, but health advisers can make referrals to local
practitioners or local resources when needed. Though
there is no analogue to MedicallHome’s national network
of providers, ConsejoSano has developed a clinic locator
system (currently operating for California and Texas)
that allows call center doctors to find local providers
with bilingual staff, based on a caller’s zip code. For
uninsured callers, the system identifies federally qualified
health centers and free clinics and can facilitate priority
Helping Hispanics Integrate into the U.S. Health
Care System
appointments. For corporate customers, they can identify
ConsejoSano is designed to support integration with the
employee benefits package that are more cost-effective
existing health system, rather than bypassing it. Hispanics
than urgent care or the emergency department.
in-network providers and discuss options included in the
We are the missing link in tying the patient
to the health system in the U.S. We are not
stealing patients from doctors in the U.S.; we are
encouraging our customers to see their doctors in
the U.S. and establish a primary care relationship.
Alfredo Ratniewski, M.D.
ConsejoSano medical director
commonwealthfund.org
Case Study, August 2017
Bridging the Health Care Gap Through Telehealth: The MedicallHome and ConsejoSano Models
CONSEJOSANO’S DOCTOR NAVIGATORS
A ConsejoSano client called to receive advice
about her 73-year-old mother, who lives in
another city and suffers from high blood
pressure. On the day of the call, her mother’s
blood pressure had surged to above 200 mm/
Hg, though she did not have any symptoms at
the time. The doctor navigator explained the
risks and potential complications of having
uncontrolled high blood pressure. The caller
was informed that it was imperative to seek
immediate medical attention for her mother at
a primary care facility, an urgent care clinic, or
an emergency department.
A middle-aged ConsejoSano client called
regarding test results she received from her
primary care doctor. Her hemoglobin A1c
level was 6.9, and her doctor informed her that
while that result was good, she was diabetic.
The patient was confused and uncertain
about how to proceed. The doctor navigator
explained what the test results meant, what
levels were considered normal and abnormal,
and spoke to her about diabetes in general,
emphasizing nutrition, exercise, and ways
to optimize treatment. The doctor navigator
also emphasized the importance of following
treatment, and urged her to follow up regularly
with her primary care doctor.
commonwealthfund.org
6
ConsejoSano also offers educational videos for its
customers, focused on preventive care and patient
engagement. For example, one video explains how to
use health insurance and the meaning of terms like
“copayment” and “deductible.” Another video offers
tips on healthy eating, using foods common to the Latin
American diet.
ConsejoSano has attracted interested from employers
seeking cost-effective health care services for their
employees. In January 2016, Mercer, a global consulting
firm that brokers health services for large corporations’
health plans, officially announced its alliance with
ConsejoSano as a preferred vendor and ConsejoSano
has since signed on large clients such as LaSalle Medical
Associates and Unite Here Health.
The model’s emphasis on triaging patients to the most
appropriate and efficient use of care could lead to cost
savings in the U.S., helping people take advantage of
less expensive resources in their communities and/or
addressing medical problems before they become urgent.
ConsejoSano reports that preliminary data indicate use of
the call center service leads to a virtuous cycle of patient
satisfaction and greater willingness to seek care in the
future. The service also could help employees stay healthy
and reduce absenteeism, although the data are insufficient
to draw conclusions. ConsejoSano is partnering with
LaSalle Medical Associates in California to test whether
tailored text messaging can drive higher compliance
with health care quality measures, such as childhood
immunization rates, among a patient population that is
covered largely by Medicaid.
CHALLENGES
One challenge facing the ConsejoSano model is that
Spanish-speaking doctors in the call center are located
and licensed in Mexico. ConsejoSano operates as a health
navigation service, and its providers are legally prevented
from establishing doctor–patient relationships with
callers from the U.S. Call center doctors offer general
health and wellness advice, but do not make specific
Case Study, August 2017
Bridging the Health Care Gap Through Telehealth: The MedicallHome an…
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